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Background: Throughout 2014 and 2015, 20 states (including Florida) reported over 200 cases of ocular syphilis to the Centers for Disease Control and Prevention. We aimed to determine the frequency of ocular syphilis identified in 2014–2015 in Florida and compare these cases against reported syphilis in Florida.
Methods: A suspect case of ocular syphilis was defined as a person with clinical symptoms or signs consistent with ocular disease and laboratory-confirmed syphilis of any stage. A probable case also had exam results by an ophthalmologist consistent with ocular syphilis. Syphilis case reports were extracted from January 1, 2014, through December 31, 2015, from Florida’s STD Surveillance System. Ocular syphilis cases were identified by searching the notes sections for terms related to ocular syphilis (for example, eye, uveitis, ocular, conjunctivitis, and vision). Case records were then reviewed to determine if they met the case definition. Ocular syphilis data were compared against other reported syphilis data using chi-square tests.
Results: Among the 13,003 syphilis cases reported, 42 (0.3%) had ocular syphilis. Twenty-seven of these were suspect cases, and 15 probable cases. In 2014, 9 (21.4%) ocular cases were identified compared to 33 cases (78.6%) in 2015. Partial or total blindness (27.7%) and diminished visual acuity (27.7%) were reported most frequently. Ocular syphilis cases and non-ocular cases were primarily male (92.9% vs 83.5% p=0.264) and HIV-infected (45.2%, vs 42.2% p=0.774). Ocular syphilis was less common among men who have sex with men (59.5% vs 74.0% p=0.044), and was more frequently classified as late-latent syphilis ((50% vs 38.8%) p=0.0001).
Conclusions: Risk factors for ocular syphilis appear similar to those for syphilis without ocular manifestations. Health care providers and ocular specialists should consider testing patients for syphilis when they have ocular manifestations consistent with ocular syphilis.